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Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications_2807

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Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications_2807

    Anterior chamber Ahmed aqueous drainage implantation for refractory glaucoma prevention and treatment of complications

     Author: Wang Hai-ying, Sheng Xiao Jie, Sun Yan,

    Zhu Hongli

     Abstract Objective: To evaluate the anterior chamber

    Ahmed aqueous drainage implantation in the treatment of refractory glaucoma surgery in the prevention and treatment of postoperative complications and improve surgical success rate. Methods: 2003/2005 line between the anterior chamber in my

    hospital Ahmed, after implantation of aqueous drainage in 20 patients with refractory glaucoma in patients with intraoperative and postoperative complications were analyzed retrospectively. Results: The follow-up time of 4 ~ 23mo. The

    average intraocular pressure level from 35.3 ? 5.2mmHg (1mmHg

    = 0.133kPa) reduced to 18.6 ? 4.4mmHg, the success rate was

    90%. 13 cases of complete success (65%), including 4 cases of early hypotony, shallow anterior chamber in 6 cases, hyphema in 4 cases, obstruction of drainage tubes in 3 cases, 1 case of choroidal detachment; five cases of conditions, successful (25% ) including drainage plate fibrosis in 4 cases, an outbreak of choroidal hemorrhage in 1, still need to be complemented by IOP lowering medications to control IOP; two

    cases because of persistent high intraocular pressure leads to failure. Conclusion: The anterior chamber aqueous Ahmed drainage implant surgery and postoperative complications matter a lot more complicated hair, but after a timely and

    appropriate treatment can achieve the desired effect.

     Key words complications of Ahmed valve for refractory glaucoma the anterior chamber

     0 Introduction

     The anterior chamber Ahmed glaucoma valve (AGV) implantation on anterior chamber depth for the application of

    a good refractory glaucoma surgery classic style, its simple, clear anatomical structure, it is appropriate to master. But the AGV implantation and early postoperative prone to shallow anterior chamber, low intraocular pressure and a series of

    complications, such as improper handling will cause injury to the cornea, anterior chamber hemorrhage, and even surgery fails. To improve the success rate of surgery, we have in our hospital since the 2003-12 pre-chamber AGV implantation

    surgery and postoperative complications in patients with symptomatic treatment, and were retrospectively analyzed to compare their preoperative and postoperative intraocular pressure control of AGV implantation effects, analyzed as follows.

     An object and method

     1.1 Object 13 males and 7 females, a total of 20. Age 41 to 78 (mean 51.6) years, ECCE surgery in 4 cases, ECCE IOL implantation in 7 cases, 4 cases, after repeated

    trabeculectomy, neovascular glaucoma in 4 cases, glaucoma, a cataract uveitis cases, preoperative mean IOP 35.3 ? 5.2mmHg

    (1mmHg = 0.133kPa), intraocular pressure lowering medications ineffective, continuous decline in visual acuity.

     1.2 Methods of conventional retrobulbar anesthesia select the appropriate quadrant two rectus intercropping a 90 ?

    range to the basement vault of the conjunctival flap, sneak separate fascia and the sclera, reaching back equator of the eye; in equatorial scleral surface of the fascia organization placed under the 0.4g / L MMC 3 ~ 5min, 20mLNS washing; for

    5mm × 6mm to limbal basement of the scleral flap, equivalent

to 1 / 2 full-thickness sclera to reach within the

    corneoscleral margin of 0.5mm; take Ahmed glaucoma valve, since the drainage tube into the saline solution in order to confirm the valve opening unobstructed. Without any resistance cases, the drainage plate Ahmed glaucoma valve placed between the two rectus sclera surface, and riding across the equator in the eye department, so that drainage tube directly at the center of corneal scleral flap diameter line, in the post-8mm

    with limbal 5-0 nylon line will drain plate front-end 2 fixed

    fixed 2-pin hole and the sclera; syringes with needles on the 7th line of puncture corneoscleral margin. In the corneoscleral margin of the anterior chamber drainage tube

    into the appropriate position, with 2mL syringe containing normal saline with 7 needles OK corneoscleral margin of puncture, the needle parallel to the iris surface into the anterior chamber, anterior chamber needle withdrawn before the

    injection of a small amount of physical saline in order to deepen the anterior chamber; placed drainage tube placed before the front end of its predicted length of the corneal surface, and then cut into a drainage tube into the anterior chamber can be 2 ~ 3mm of the 45 ? ramp up the appropriate

    length of insertion with flat tweezer to live into the anterior chamber drainage tube carefully to ensure the drainage pipe and parallel to the surface instead of the iris and the iris and corneal endothelium contact, and to incline

    towards the drainage tube the inner surface of the cornea; to cover the scleral flap drainage tube, or use some variant of the 4mm × 5mm sclera covering the drainage pipe near the limbus and the flap corners and two at the waist line with

    interrupted 10-0 nylon suture in situ 4-pin. 10-0 nylon suture

    fixation drainage tube in the sclera, and the roots of a temporary drainage tube ligation with 10-0 nylon thread at the

    same time sutured bulbar conjunctiva and fascia. Postoperative subconjunctival injection of dexamethasone 2.5mg and gentamicin 20000 U. Surgical success criteria: complete success: no lowering intraocular pressure in patients with ocular hypertension drug under the conditions of <21mmHg; conditions for success: Topical application of lowering

    intraocular pressure in patients with drug-point eye

    conditions, the intraocular pressure <21mmHg; failure: local administration can not control the intraocular pressure is required Further-line anti-glaucoma surgery.

     2 Results

     Follow-up time of 4 to 23 (average 10.2) mo. Mean

    preoperative IOP 35.3 ? 5.2mmHg, mean postoperative IOP 18.6

    ? 4.4mmHg. The overall success rate of 90%. Postoperative visual acuity was improved two lines or two lines above seven to improve a line or the same 8, 5 decreased vision.

    Complications: 13 patients achieved complete success (65%), including 4 cases of early hypotony, shallow anterior chamber in 6 cases, hyphema in 4 cases, obstruction of drainage tubes in 3 cases, 1 case of choroidal detachment; five cases of

    successful conditions (25%), including drainage plate fibrosis in 4 cases, an outbreak of choroidal hemorrhage in 1, still need to be complemented by IOP lowering medications to control IOP; two cases because of persistent high intraocular pressure

    leads to failure.

     3 Discussion

     Ahmed valve (USA) consists of two parts: first, drainage pipe, the water will drain into the anterior chamber disc at the remote drainage; second drainage plate, through the implantation of drainage plate after plate formation and

    drainage around the disk surface area the same fibrous liquid storage space. Aqueous drainage through the drainage tube into the liquid storage space, and then through the wall of the gap surrounding the fiber is absorbed within the organization to

    achieve the purpose of lowering intraocular pressure. It is unique is that in the drainage plate attached to the front of the mouth with a hose shrink the role of physics in aqueous control room, exit the room there is one made of elastic

    silicone pressure-sensitive valve, the valve in the former Housing Pressure> 1.07 ~ 1.33kPa pm to 2 ~ 3μL aqueous Zeyi

    the slow rate of flow of drainage tray.

     Anterior chamber Ahmed glaucoma valve (AGV) implantation success rate, and intraoperative and postoperative preventive measures in a timely manner closely related. AGV implantation of anterior chamber of the most common and one of the most serious complication of hypotony and shallow anterior chamber

[2]. Mainly due to drainage is too strong, due to early

    postoperative aqueous humor drainage volume larger, this group of patients in six cases of anterior chamber appeared shallow anterior chamber in the formation of its slow, 4 cases of early hypotony may be related to drainage tube in the anterior

    chamber, the Housing the water directly through the drainage tube rapidly excreted rapidly reduce the volume of the anterior chamber; or may be due to the entrance of the anterior chamber drainage tube inserted around the leakage and / or ciliary inhibition, therefore, we believe that excessive restrictions on early postoperative aqueous humor discharge was postoperative hypotony, shallow anterior chamber of the key [2-6], in order to avoid such complications, there have been some improved surgical. The group catheter implantation in some cases an application of a temporary absorbable suture ligation of catheter root method [7], while dense scleral flap suture and catheter mattress suture. If necessary, repair the conjunctiva lines. The patients, 1 patients with choroidal

    detachment, after conservative treatment and cure of drug. Is generally believed that the incidence of choroidal detachment with early postoperative hypotony and vascular expansion, plasma extravasation on [2,8,9]. 1 case of fulminant choroidal

    hemorrhage, surgery to detect line immediately after the scleral incision and drainage, joint bleeding drugs to achieve good results in the preservation of vision. Patients in this group except for 2 patients with persistent high intraocular

    pressure than the rest are all well transferred.

     In addition, in order to avoid a number of other complications, intraoperative and postoperative We both had properly dealt with. When drainage tube into the anterior chamber parallel to the iris to avoid contact with the corneal endothelium and iris. We use intraoperative immediate formation of the anterior chamber a way to observe the anterior chamber drainage tube after the formation of mouth location, and easy to observe the status of the early

    drainage. Also to avoid the sudden drop in intraocular hemorrhage intraocular pressure and choroidal detachment; temporary drainage tube ligation surgery can avoid the early hypotony, shallow anterior chamber. The key is anterior chamber AGV surgery of the anterior chamber after the

    formation of a stable state of the anterior chamber and cause a clean environment to prevent complications of the anterior

    chamber and cause obstruction of drainage tubes. Therefore, the operation of a gentle and accurate intraoperative and

    postoperative management properly is vital. Drainage tube to avoid the area blood vessels into the anterior chamber of iris thick, intraoperative anterior chamber formed immediately and after application of hemostatic agents and corticosteroids and

    prostaglandin inhibitors, to prevent the expansion of low-

    tension re-bleeding and blood vessels anterior chamber exudation have a certain effect. Reposted elsewhere in the paper for free download http://

     AGV implant surgery before the chamber was first

    implanted valve to fully separate the ball where the equatorial region organized under the conjunctiva and the conjunctiva, so that the formation around the implant plate in order to facilitate an adequate compartment forming a cavity leakage effect, reaching a more effective antihypertensive effect. To prevent drainage valve disc of the surrounding tissue machine package, in surgery, to be placed around the drain valve disc MMC, in order to further improve the surgical success rate. Especially for young patients or the estimated drainage tray weeks fibrous proliferation of the more serious cases [10].

     In case of tube blockage, we can be different scenarios based on hit radio YAG laser catheter port plug things or limbal paracentesis In addition to plug things aside, so that catheter drainage tube washed re-opening, if necessary, to re-

    open the conjunctival flap and part of the sclera valve, remove the drainage tube end of the anterior chamber to clear blocked drainage tube at the end of things, and use a balanced

    salt 4, the needle inserted through the mouth tube drainage dish washing to uplift the conjunctiva weeks, and then drainage tube implant.

     Early postoperative high intraocular pressure has not formed a drainage tray fiber wrapped film weeks in advance,

    before the amount of early ocular massage was very useful. Acupressure through the eye, or subconjunctival injection of MMC or 5-FU, or in a timely manner after the drainage around the plate with anti-proliferative agents fibers, such as the

contralateral eye subconjunctival injection of 5-FU, so as to

    prevent the proliferation of scar occurred, most of Patients will be a success [5].

     When the package has become apparent non-fiber membrane

    filtration when the detailed report on the handling of the

    very few [10,11], the current approach wrapped fiber membrane excision combined with MMC: re-open the conjunctival flap,

    separating the conjunctiva and sclera and conjunctiva and the drainage plate between the membrane wrapped around the fibers

    of scar tissue in the conjunctiva and packages membrane placed between 0.4g / L MMC 3 ~ 5min, with 20mL saline flush balanced drainage after the removal of the surface of the fiber wrapped disk membrane, exposing the complete drainage tray . When you

    see the continuous removal of aqueous humor outflow, intraocular pressure decline in some patients with shallow anterior chamber that AGV unobstructed drainage of aqueous, valves Branch no adhesion. After an early eye acupressure. The remedial surgery is a simple and effective approach to reduce the additional cost of re-implanted in the ciliary body

    destructive spending and to avoid the risk of post-operative

    ocular atrophy [12,13].

     AGV is targeted anterior chamber ocular trauma and

    surgery caused by a conjunctiva, sclera scarring, or neovascular glaucoma trabeculectomy is no longer routine conditions, avoiding the eyes easy to knot the Department of scar tissue, with glaucoma valve to room water drainage to the sclera in the equatorial surface of the drainage plate to form a loose cellular connective tissue around the cysts, aqueous humor and thus passive diffusion or infiltration into the orbit of tissue capillaries and lymphatic space was absorbed by the formation of a permanent aqueous drainage channels .

    Because the eye conjunctiva rear fascia for additional drainage of surface area of great potential, and the conjunctiva over the front to make room for more effective absorption of water is blood vessels, and at the rear of the drainage cavity away from the front of the scar area easy to knot and other reasons, to make this procedure more advantages. If timely and effective treatment intraoperative and postoperative complications, and its success rate will hopefully greatly improved, and truly bring good news to

patients with refractory glaucoma.

     References

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